While the world was questioning if people would not be immune to COVID-19 after having recovered from COVID-19, and panicking about whether or not doors and walls were being cleaned fastidiously enough, I was determined to make public health groups aware that the only way we would REALLY be able to get out of the pandemic was by vaccination of the population (and/or acquired immunity).

Virologically and immunologically, nobody with any real knowledge thought seriously from the outset that recovered patients wouldn’t be immune, but the scaremongering media made it their collective mission to grab on to the latest non-scientific soundbite or headline in order to sell more papers (or ad revenue slots). It’s a continuation across a different medium of the moniker, “If it bleeds, it leads,” which refers to news stories involving trauma or bloodshed getting ‘more eyes,’ in the parlance of the journalism industry.

While I write this article, we have (in the U.S.) two authorized mRNA vaccines, and J&J (via Janssen) will be seeking EUA (Emergency Use Authorization) at the end of this month (February). So, by the time you read this column, the die will have been cast, and their AD.COV.26 vaccine, based on an adenoviral-26 vector, will either have been authorized or not.

I had previously predicted for other media outlets the very week of J&J’s filing for EUA (as well as the outcomes for Moderna and Pfizer/BioNTech), so I’m going to prognosticate here that Janssen’s vaccine candidate will get the greenlight from the Vaccines and Related Biological Products (VRBP) Advisory Committee to recommend to the FDA for an EUA. This will give us 3 major shots (literally and figuratively) in the fight against SARS-CoV-2. But as the former Surgeon General of the United States, C. Everett Koop once said, “drugs only work in people who take them.” That’s also true of vaccines. Unless there is broad uptake globally (not just nationally!), we won’t get ahead of the vectors to sufficiently reduce R0 to make it disappear.

But the footnote on this part of the story, as hedged now by this author, for the backward-looking lens of the future thinking back to this point and how well-prepared and accurate we were in our assessments and theories: A betacoronavirus like SARS-CoV-2 (perhaps a distant mutation) will more than likely continue circulating indefinitely now, and perhaps it becomes something for which we develop a routine booster shot (like influenza). In my estimation, we won’t be rid of this pathogen (or a derivative) anytime soon, because its mutations make it very comfortable persisting among humanity very insidiously, and sometimes even innocuously.

We’re currently tracking variants, which include B.1.1.7, B.1.351, 501.Y2, P.1, and P.2. There are of course countless others, but the ones which concern me and others in the virology and vaccinology world are those which yield many of their specific mutations on the spike (S) glycoprotein. This part of the whole virus is really the entirety of the business end. It is how this virus attaches and gains access to cells in the body. It’s also how the body is recognizing parts of the virus in order for immunity to prevent future cases. If the new variants look ‘different enough,’ they will evade antibodies and cause the mounting of novel immune responses (and catalyze the development of new vaccines and treatments).

In my estimation, looking at SIR epidemiological curves and population response makes me realize that COVID-19 won’t simply disappear. So, we need to proactively plan for when we deem it appropriate to stand-down on the nomenclature of global “pandemic” to allow the population to effectively get back to municipal planning and execution for a future wherein we live alongside mutating betacoronaviruses. We can’t keep the curtain closed forever. Nor can we open it without first coming up with a plan for how we do so.

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Ben Locwin
Contributing Editor

Dr. Ben Locwin, a health care executive, has worked on vaccinology and virology advisory boards, and has been on the front lines of the national coronavirus pandemic, participating in public health policy groups, and providing recommendations for government and private sector response amid its continued impact to public health and world economies. He has also worked closely with the FDA and the CDC.